Asthma, COPD and Diabetes Preferred Drug List Medications



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GPI Name Dexamethasone Tab 0.5 MG Dexamethasone Tab 0.75 MG Dexamethasone Tab 1 MG Dexamethasone Tab 1.5 MG Dexamethasone Tab 2 MG Dexamethasone Tab 4 MG Dexamethasone Tab 6 MG Dexamethasone Elixir 0.5 MG/5ML Dexamethasone Soln 0.5 MG/5ML Hydrocortisone Tab 5 MG Hydrocortisone Tab 10 MG Hydrocortisone Tab 20 MG Methylprednisolone Tab 4 MG Methylprednisolone Tab 8 MG Methylprednisolone Tab 4 MG Dose Pack Prednisolone Tab 5 MG Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent) Prednisolone Sod Phosphate Oral Soln 15 MG/5ML (Base Equiv) Prednisolone Sod Phosph Oral Soln 6.7 MG/5ML (5 MG/5ML Base) Prednisolone Sod Phosphate Oral Soln 20 MG/5ML (Base Equiv) Prednisone Tab 1 MG Prednisone Tab 2.5 MG Prednisone Tab 5 MG Prednisone Tab 10 MG Prednisone Tab 20 MG Prednisone Tab 50 MG Prednisone Conc 5 MG/ML Prednisone Oral Soln 5 MG/5ML Prednisone Tab 5 MG Dose Pack Prednisone Tab 10 MG Dose Pack Fludrocortisone Acetate Tab 0.1 MG Cromolyn Sodium Soln Nebu 20 MG/2ML Albuterol Sulfate Tab 2 MG Albuterol Sulfate Tab 4 MG Albuterol Sulfate Syrup 2 MG/5ML

Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML) Albuterol Sulfate Soln Nebu 0.5% (5 MG/ML) Albuterol Sulfate Soln Nebu 0.63 MG/3ML (Base Equiv) Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv) Albuterol Sulfate Inhal Aero 108 MCG/ACT (90MCG Base Equiv) Formoterol Fumarate Inhal Cap 12 MCG Salmeterol Xinafoate Aer Pow BA 50 MCG/DOSE (Base Equiv) Terbutaline Sulfate Tab 2.5 MG Terbutaline Sulfate Tab 5 MG Budesonide-Formoterol Fumarate Dihyd Aerosol 80-4.5 MCG/ACT Budesonide-Formoterol Fumarate Dihyd Aerosol 160-4.5 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 45-21 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 115-21 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 230-21 MCG/ACT Fluticasone-Salmeterol Aer Powder BA 100-50 MCG/DOSE Fluticasone-Salmeterol Aer Powder BA 250-50 MCG/DOSE Fluticasone-Salmeterol Aer Powder BA 500-50 MCG/DOSE Mometasone Furoate-Formoterol Fumarate Aerosol 100-5 MCG/ACT Mometasone Furoate-Formoterol Fumarate Aerosol 200-5 MCG/ACT Theophylline Cap SR 24HR 200 MG Theophylline Cap SR 24HR 300 MG Theophylline Tab SR 12HR 100 MG Theophylline Tab SR 12HR 200 MG Theophylline Tab SR 12HR 300 MG Theophylline Tab SR 24HR 400 MG Budesonide Inhalation Susp 0.25 MG/2ML Budesonide Inhalation Susp 0.5 MG/2ML Budesonide Inhalation Susp 1 MG/2ML Budesonide Inhal Aero Powd 90 MCG/ACT (Breath Activated) Budesonide Inhal Aero Powd 180 MCG/ACT (Breath Activated) Flunisolide HFA Inhal Aerosol 80 MCG/ACT Fluticasone Propionate Aer Pow BA 50 MCG/BLISTER Fluticasone Propionate Aer Pow BA 100 MCG/BLISTER Fluticasone Propionate Aer Pow BA 250 MCG/BLISTER Fluticasone Propionate HFA Inhal Aero 44 MCG/ACT (50/Valve) Fluticasone Propionate HFA Inhal Aer 110 MCG/ACT (125/Valve)

Fluticasone Propionate HFA Inhal Aerosol 220 MCG/ACT Montelukast Sodium Tab 10 MG (Base Equiv) Montelukast Sodium Chew Tab 4 MG (Base Equiv) Montelukast Sodium Chew Tab 5 MG (Base Equiv) Montelukast Sodium Oral Granules Packet 4 MG (Base Equiv) Insulin Aspart Inj 100 Unit/ML Insulin Aspart Soln Pen-injector 100 Unit/ML Insulin Aspart Soln Cartridge 100 Unit/ML Insulin Glargine Inj 100 Unit/ML Insulin Glargine Soln Pen-Injector 100 Unit/ML Insulin Glulisine Inj 100 Unit/ML Insulin Glulisine Soln Pen-Injector Inj 100 Unit/ML Insulin Lispro (Human) Inj 100 Unit/ML Insulin Lispro (Human) Soln Pen-injector 100 Unit/ML Insulin Lispro (Human) Soln Cartridge 100 Unit/ML Insulin Regular (Human) Inj 100 Unit/ML Insulin Isophane (Human) Inj 100 Unit/ML Insulin Isophane (Human) Susp Pen-injector 100 Unit/ML Insulin Aspart Prot & Aspart (Human) Inj 100 Unit/ML (70-30) Insulin Aspart Prot & Aspart Sus Pen-inj 100 Unit/ML (70-30) Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (75-25) Insulin Lispro Prot & Lispro (Human) Inj 100 Unit/ML (50-50) Insulin Lispro Prot & Lispro Sus Pen-inj 100 Unit/ML (75-25) Insulin Isophane & Regular (Human) Inj 100 Unit/ML (70-30) Glimepiride Tab 1 MG Glimepiride Tab 2 MG Glimepiride Tab 4 MG Glipizide Tab 5 MG Glipizide Tab 10 MG Glipizide Tab SR 24HR 2.5 MG Glipizide Tab SR 24HR 5 MG Glipizide Tab SR 24HR 10 MG Glyburide Tab 1.25 MG Glyburide Tab 2.5 MG Glyburide Tab 5 MG Metformin HCl Tab 500 MG

Metformin HCl Tab 850 MG Metformin HCl Tab 1000 MG Metformin HCl Tab SR 24HR 500 MG Metformin HCl Tab SR 24HR 750 MG Linagliptin Tab 5 MG Saxagliptin HCl Tab 2.5 MG (Base Equiv) Saxagliptin HCl Tab 5 MG (Base Equiv) Pioglitazone HCl Tab 15 MG (Base Equiv) Pioglitazone HCl Tab 30 MG (Base Equiv) Pioglitazone HCl Tab 45 MG (Base Equiv) Linagliptin-Metformin HCl Tab 2.5-500 MG Linagliptin-Metformin HCl Tab 2.5-850 MG Linagliptin-Metformin HCl Tab 2.5-1000 MG Saxagliptin-Metformin HCl Tab SR 24HR 2.5-1000 MG Saxagliptin-Metformin HCl Tab SR 24HR 5-500 MG Saxagliptin-Metformin HCl Tab SR 24HR 5-1000 MG Glipizide-Metformin HCl Tab 2.5-250 MG Glipizide-Metformin HCl Tab 2.5-500 MG Glipizide-Metformin HCl Tab 5-500 MG Glyburide-Metformin Tab 2.5-500 MG Glyburide-Metformin Tab 5-500 MG Pioglitazone HCl-Metformin HCl Tab 15-500 MG Pioglitazone HCl-Metformin HCl Tab 15-850 MG Ipratropium Bromide Inhal Soln 0.02% Ipratropium Bromide HFA Inhal Aerosol 17 MCG/ACT Tiotropium Bromide Monohydrate Inhal Cap 18 MCG (Base Equiv) Formoterol Fumarate Inhal Cap 12 MCG Salmeterol Xinafoate Aer Pow BA 50 MCG/DOSE (Base Equiv) Ipratropium-Albuterol Nebu Soln 0.5-2.5(3) MG/3ML Ipratropium-Albuterol Aerosol 18-103 MCG/ACT (20-120MCG/ACT) Ipratropium-Albuterol Inhal Aerosol Soln 20-100 MCG/ACT Budesonide-Formoterol Fumarate Dihyd Aerosol 80-4.5 MCG/ACT Budesonide-Formoterol Fumarate Dihyd Aerosol 160-4.5 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 45-21 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 115-21 MCG/ACT Fluticasone-Salmeterol Inhal Aerosol 230-21 MCG/ACT

Fluticasone-Salmeterol Aer Powder BA 100-50 MCG/DOSE Fluticasone-Salmeterol Aer Powder BA 250-50 MCG/DOSE Fluticasone-Salmeterol Aer Powder BA 500-50 MCG/DOSE Theophylline Cap SR 24HR 200 MG Theophylline Cap SR 24HR 300 MG Theophylline Tab SR 12HR 100 MG Theophylline Tab SR 12HR 200 MG Theophylline Tab SR 12HR 300 MG Theophylline Tab SR 24HR 400 MG Budesonide Inhalation Susp 1 MG/2ML Budesonide Inhal Aero Powd 90 MCG/ACT (Breath Activated) Budesonide Inhal Aero Powd 180 MCG/ACT (Breath Activated) Ipratropium Bromide Inhal Soln 0.02% Ipratropium Bromide HFA Inhal Aerosol 17 MCG/ACT Tiotropium Bromide Monohydrate Inhal Cap 18 MCG (Base Equiv) Ipratropium-Albuterol Nebu Soln 0.5-2.5(3) MG/3ML Ipratropium-Albuterol Aerosol 18-103 MCG/ACT (20-120MCG/ACT) Ipratropium-Albuterol Inhal Aerosol Soln 20-100 MCG/ACT